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Some men reach orgasm and discharge semen from the penis (ejaculate) within 5 minutes of sex. Others, 15 or 20 minutes. When ejaculating takes longer than 25 or 30 minutes or doesn’t happen, you might have delayed ejaculation (DE) (Di Sante, 2016).
This article looks at what delayed ejaculation is, its types, causes, and treatment options.
What is delayed ejaculation?
Occurring in 1–4% of sexually active men, delayed ejaculation is a condition that occurs when a person does not ejaculate within a reasonable time (typically within 25 or 30 minutes) after sexual stimulation (Di Sante, 2016).
Now, not ejaculating or ejaculating 30 minutes after sex one time does not mean you have delayed ejaculation or another form of sexual dysfunction. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), here’s what’s needed to receive a delayed ejaculation diagnosis (Di Sante, 2016):
- Significant delay in ejaculating or infrequent or no ejaculation 75–100% of the time you’ve had sex in the past six months.
- You feel distressed from not ejaculating when you want to.
Types of delayed ejaculation
Delayed ejaculation can either be lifelong or acquired and can be general—happening in all sexual encounters—or situational (under specific circumstances).
Lifelong delayed ejaculation is also known as primary delayed ejaculation. Here, the person experiences delayed ejaculation from the first time they had sexual intercourse. It occurs in 25% of delayed ejaculation cases (McMahon, 2014).
Acquired delayed ejaculation or secondary delayed ejaculation develops later in life. It happens in 75% of people with delayed ejaculation (McMahon, 2014).
What causes delayed ejaculation?
A person may have problems climaxing and ejaculating when they want to for many reasons. These reasons could be physical, psychological, or both. Let’s take a look at some of them.
Physical causes of delayed ejaculation
Health conditions, genetic abnormalities, surgery, or medications that affect the nerves can cause delayed ejaculation.
Some of the medical conditions that may be underlying causes of delayed ejaculation include (Abdel-Hammid, 2018):
- Spinal cord injury
- Nerve damage with diabetes (diabetic neuropathy)
- Multiple sclerosis
- Abdominal aortic aneurysm (AAA), a swelling or bulging of the aorta, the largest blood vessel in the body
- Urethral injury
Surgeries or treatments that can cause delayed ejaculation are (Abdel-Hammid, 2018):
Aging can also contribute to delayed ejaculation. Reduced penis sensitivity that comes with aging may make it harder for a person to climax and ejaculate. Age-related conditions like depression, diabetes, testosterone deficiency, or treatment for age-related diseases can also cause difficulty ejaculating (Abdel-Hammid, 2018).
When there’s a problem with the production of hormones that help in ejaculating, a person may experience DE. Hormonal disorders that can cause delayed ejaculation are (Abdel-Hammid, 2018):
- Hypogonadism: This condition occurs when the sex glands don’t produce enough or any sex hormones.
- Hypothyroidism: This condition happens when the thyroid produces inadequate thyroid hormones for your body.
- Hyperprolactinemia: This disorder occurs when the body produces too much prolactin, a hormone that allows the breasts to grow and produce milk
Delayed ejaculation may also be a side effect of medications or substances, including (Abdel-Hammid, 2018):
- Antidepressants like selective serotonin reuptake inhibitors (SSRIs)
- Pain relievers like naproxen
- Anti-anxiety medications
- Muscle relaxers
- Epilepsy medications
- High blood pressure medications
Psychological causes of delayed ejaculation
Aside from the physical causes of DE, psychological factors may also play a role in delayed ejaculation. For example, sometimes, you might have delayed ejaculation if you are not sufficiently sexually stimulated (Abdel-Hammid, 2018)
Other psychological factors include (Abdel-Hammid, 2018):
- Fear of getting your partner pregnant or having fertility problems
- Intimacy fears
- Fear of losing self-control
- Fear of rejection from your partner
- Fear of hurting your partner
- Having sex with a gender you’re not sexually attracted to
- Unresolved fights with your partner
- Performance anxiety about your sexual function
- Religious guilt about having sex
- Autosexuality (sexual attraction to yourself making you prefer sex with yourself than with others)
- Low sexual desire
Delayed ejaculation may also be a symptom of mental health disorders like depression and anxiety.
Delayed ejaculation treatment
There’s no standard way to diagnose delayed ejaculation. Typically, a healthcare provider will do a physical examination and look at your medical and sexual history and symptom report before giving a delayed ejaculation diagnosis (McMahon, 2014).
They will then recommend a treatment plan based on what might be causing your issues.
Treatment options for delayed ejaculation include:
If your provider suspects that you cannot climax and ejaculate because of psychological factors, they might refer you to a psychologist or therapist for treatment.
Therapy may involve treating fears, depression, anxiety, or other mental conditions that may be causing your delayed ejaculation.
For instance, if you can’t ejaculate when having sex with your partner because of a relationship conflict, the therapist may work with you to resolve any issues and build a healthier relationship. Sex therapy may also help improve delayed ejaculation (Abdel-Hammid, 2018).
The FDA hasn’t approved any medications for delayed ejaculation, so any drug used to treat delayed ejaculation is considered off-label. These medications may help a person ejaculate, but more research is needed for many of these drugs). Also, they may come with side effects like hypertension, abdominal pain, insomnia, and more (Shindel, 2022; Abdel-Hammid, 2018).
If your healthcare provider thinks that you would benefit from an off-label medication to treat your DE, they may recommend (Abdel-Hammid, 2018):
- Testosterone treatment for treating low testosterone
- Cabergoline (Dostinex) to lower prolactin levels
- Bupropion (Wellbutrin and Zyban; see Important Safety Information), an antidepressant.
- Amantadine (Gocovri, Symmetrel, and others), a medication for Parkinson’s disease
- Cyproheptadine (Periactin), a drug that affects brain chemicals like serotonin
- Bethanechol (Urecholine), a prescription for treating difficulties urinating
If you’re trying to have a baby and your delayed ejaculation is affecting your ability to conceive, your healthcare provider may recommend certain therapies to collect semen for fertility purposes.
The bottom line on delayed ejaculation
Sex with your partner can become a chore if you have trouble ejaculating. Delayed ejaculation may also be a source of stress and frustration and can affect your sex life or your sexual relationship with your partner. While its causes range from a handful of medical conditions to various psychological factors, there are treatments that may help.
Reach out to a healthcare professional who can recommend treatment—depending on the cause of your DE—that can help you ejaculate on time.
- Abdel-Hamid, I. A. & Ali, O. I. (2018). Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment. The World Journal of Men’s Health, 36(1), 22–40. doi:10.5534/wjmh.17051. Retrieved from https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051
- Abdel-Hamid, I. A., Elsaied, M. A., & Mostafa, T. (2016). The drug treatment of delayed ejaculation. Translational Andrology and Urology, 5(4), 576–591. doi:10.21037/tau.2016.05.05. Retrieved from https://tau.amegroups.com/article/view/10477/11781
- Di Sante, S., Mollaioli, D., Gravina, G. L., et al (2016). Epidemiology of delayed ejaculation. Translational Andrology and Urology, 5(4), 541–548. doi:10.21037/tau.2016.05.10. Retrieved from https://tau.amegroups.com/article/view/10793/11774
- McMahon, C. G. (2014). Management of ejaculatory dysfunction. Internal Medicine Journal, 44(2), 124–131. doi:10.1111/imj.12344. Retrieved from https://onlinelibrary.wiley.com/doi/10.1111/imj.12344
- Shindel, A. W., Althof, S. E., Carrier, S., et al. (2022). Disorders of Ejaculation: An AUA/SMSNA Guideline. The Journal of Urology, 207(3), 504–512. doi:10.1097/JU.0000000000002392. Retrieved from https://www.auajournals.org/doi/10.1097/JU.0000000000002392
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.